Meds in the near future

[sacinsc]

OK, was told by my ID doc in DC yesterday (monday) that if my levels didnt correct themselves that he wanted to go more aggressive on the virus, which I am fine with. What I havent done at all is research the meds yet since I have been diagnosed only since the beginning of September and was told that I probably would be going on meds for at least six months if not a year. So i was caught off guard by that. I will begin researching meds, but we all know that first hand experience with them is the best source of information. Can you guys advise me as to the different types and what I can expect? My strain of virus is not immune to any medications as i was told from my genotype test. While I will be looking online for info on the drugs I just want yalls input as well. Your advice hasnt failed me yet and has made me feel better.

PS wish me luck I have a job interview in DC Thursday then I fly to Orlando for a job interview there as well!

Matt

[keyite]

The important part here is that your doctor said "if my levels didnt correct themselves" - my emphasis. You really need more than one or even two sets of results to be able to determine the trend your numbers might be on. That could easily take six months, particularly because your numbers actually aren't bad at all, considering this is a relatively recent seroconversion.

Of course, there's nothing wrong with researching the options, so you're prepared when and if the time comes to start. Don't have any first-hand experience to share, but the 'lessons' on this site are a great place to start your research: http://www.aidsmeds.com/articles/TreatmentQuestions_5032.shtml

Good luck with the job interviews! 

[megasept]

The important part here is that your doctor said "if my levels didnt correct themselves" - my emphasis. You really need more than one or even two sets of results to be able to determine the trend your numbers might be on. That could easily take six months, particularly because your numbers actually aren't bad at all, considering this is a relatively recent seroconversion.

Good advice...After your numbers have leveled more or less (Look how long that took at Keyite's #s posted above---don't get screwed up by the international order of the dates), then wait until CD4 < 350 and/OR VL > 100k to start ARV therapy. That's my advice (treated 5 of 16+ yrs, currently untreated). As for meds look at article on THIS Site concerning Mercke's Raltegravir (integrase type) drug. It's to be taken in "combo." This will be my drug of choice when resuming meds sometime soon.

  -megasept

[sacinsc]

I should find out tomorrow what my levels are. My doc just said he wanted to be very aggressive with the virus and asked if I would mind going ahead and starting if things havent improved. He thinks being aggressive with it now will be better for me in the future. I know that if my CD4 has dipped below 400 he will want to put me on the meds because he said 350 is the lowest he would ever go and the new research says to start earlier.

Ive started reading a lot and he said it would be a one pill a day regimen that combines drugs. But when reading about them, the side effects sound horrifying. Thats why I really just wanted to know what to expect in the real world from real people Cause if those are the side effects I will def get, hell I think I would rather just take my chances for now!! I will look at the one you told me

Matt

Job interview #1 at 11 tomorrow at a high school then off to Florida for Job Interview #2 at a middle school in Orlando...please please please let me get one so i can get my life back on track!

[megasept]

I should find out tomorrow what my levels are. My doc just said he wanted to be very aggressive with the virus and asked if I would mind going ahead and starting if things haven't improved. He thinks being aggressive with it now will be better for me in the future. I know that if my CD4 has dipped below 400 he will want to put me on the meds because he said 350 is the lowest he would ever go and the new research says to start earlier.

Ive started reading a lot and he said it would be a one pill a day regimen that combines drugs. But when reading about them, the side effects sound horrifying. That's why I really just wanted to know what to expect in the real world from real people Cause if those are the side effects I will def get, hell I think I would rather just take my chances for now!! I will look at the one you told me

Matt

Job interview #1 at 11 tomorrow at a high school then off to Florida for Job Interview #2 at a middle school in Orlando...please please please let me get one so i can get my life back on track!

Matt; First off get one of those damn jobs! I know exactly how it feels looking for work, testing, bureaucracy (providing 3 sealed transcripts at different times to the same people), interviews...Once you get your new position, promptly forget how you got it! GOOD LUCK!

Not treating ought to be as much a thoughtful decision as treating. Doctors should have a point of view. Patients are entitled to the same. It's our health at stake.

Look, your MD might be right. "Hit it early and hit it hard" was so appealing. Only notice that mantra has disappeared over the last 7-8 years. Ask your MD why that is. My treatment/research specialists (one of whom is misquoted in news coverage)think he's wrong. Ask to read the research (the recent study and especially all the news coverage that "closed the book" on STIs is fatally flawed---PM if you'd like), not just his conclusion. It is appealing to treat right away...kill the little bastards!...I'd love to have an undetectable VL again, or 500 or more CD4s. I will get the former, and probably the latter, once I go on meds again. Meanwhile, I have managed to spare my organs, like heart and liver, from the toxicity of the drugs for eleven years total. That is an achievement. We have an incurable disease, so a little compromise is necessary to fend it off over a long time.

"Side effects" like diarrhea or LIpo (acquainted with both) are less important to me than anything life-threatening like organ failure. I am not Dorian Gray. I'd like to look pretty. But I love life even more. I might live 30 or 40 total years with HIV. Maybe I am around the half point. What I have done is controversial, but the norm, among hundreds who receive treatment at my university-run clinic. I don't tell people that they are doing the wrong thing by tenaciously taking their meds. Take the best meds and be compliant! Or don't treat. The question is which is better and when and why? The "why?" is for the scientists. The "which?" and "when?" are questions for you and me. My next drugs are going to be a world better than my last meds (3TC + D4T---which were effective). I am glad it will soon be seven years break between therapies. That's my real world advice to you.

   -megasept

[sacinsc]

I totally understand what you are saying. I am getting off one drug I take for bipolar because it affects the liver and I know that these meds do too. The question then is, when do we start? Should I wait until I get closer to 200...which scares me, or go ahead and be aggressive. I dont want to make the wrong choice.

I am petrified of the side effects and organ failures, but i thought that organ failure was not that common anymore.  I  will private you for the article and read it.

Thanks

Matt

I damn well  better get one of these jobs.

[sacinsc]

No longer in the near future, my numbers were really bad today. I am a little upset and depressed, but ill write about that in the other forum. He said I wouldnt be put on Sustiva, so what are the other options. I go see him Tuesday, but I want to be prepared. Any advice?

New numbers were CD4 296 and VL 124000

Had one interview this morning, one tomorrow morning. I hope I get one.

Matt

[megasept]

No longer in the near future, my numbers were really bad today. I am a little upset and depressed, but ill write about that in the other forum. He said I wouldn't be put on Sustiva, so what are the other options. I go see him Tuesday, but I want to be prepared. Any advice?

New numbers were CD4 296 and VL 124000

Had one interview this morning, one tomorrow morning. I hope I get one.

Matt

Those #s are not "really bad."  As others have stated (and you have only to read their posted numbers chronologically), it may take around a year, not weeks for your #s to stabilize (and most likely improve). So what's the rush to treat?

   -megasept

[sacinsc]

You really dont think a drop like that is bad? I never thought I would see my cd4 below 300. Its to close to 200. I dont want to be labeled as AIDS. My  doctor thinks now is the time and I honestly agree. I think I would be more aggressive. We have gone below the 350 line this time. I am honestly scared to death at this point.

[keyite]

What was the CD4% from your latest set of results? If I understand right, your first reading was 25%, which is pretty good.

Absolute CD4 counts jump up and down - just look at mine in my signature. The test itself has an error margin, but they're also influenced by things like the time of day the blood was drawn, any stress you're experiencing, exercise, recent vaccinations, colds and other small infections, and so on. You really cannot conclude anything from a single lab result.

The CD4 percentage, on the other hand, tends to be more stable and makes it easier to interpret the significance of any individual CD4 count result. Again, see my signature.

Look, I totally understand you're scared right now. It isn't so long ago I was where you are now and I remember the impulse to 'do something about it now' all too well. But if I were you I'd at least repeat that lab test. The result might well surprise you (positively!).

At the end of the day, if you believe treatment is the way to go (regardless of the caveats outlined so far in this thread) then you must follow that instinct. Like megasept said, it's your health that is at stake. I'd just urge you not to start meds solely because you're scared or because your doc says you should.

[sacinsc]

Well my docs top in the field, he teaches this stuff at GW. I know things bump around but to go below 300 is scary. The time of day was 11 in the morning, I felt fine, no colds or anything, been taking vitamins for my immune system (which I just tossed) and my doc says recent evidence says the % isnt that important anymore so he doesnt give it to me until I ask. I will talk to him more Tuesday, but I have resigned myself to the fact that the meds are coming. And that since Sustiva is out, it looks like AZT may be in my future which i petrified about taking.

[newt]

sac...

AZT is by no means an inevitable choice...

First-line combo is EITHER an NNRTI (eg Sustiva) OR a boosted PI (eg Reyataz + Norvir, Kaletra) + 2 nukes (eg Epzicom, Truvada, Combivr)

AZT is a nuke.

Unless you have a particular kind of resistance, there is no reasons why you need to try Combivir, the AZT containing nuke pair in the list above, unless you don't get on well with Epzicom (abacavir + 3TC) or Truvada (tenofovir + FTC).

- matt

[sacinsc]

OK, but question, if I he has already told me that Sustiva is out because I already have anger issues and that may cause it to get worse, what do you think and know you cant really predict, but what do you think would be the logical selections....I want to go in prepared for anything he throws at me for side effects.

[newt]

SAC

This discussion is a bit previous given your recent seroconversion, and your body still finding a balance with the virus etc.

However, in case you decide to do the treat early thing, or your CD4 count don't recover:

Sustiva or Viramune + 2 nukes
A boosted PI + 2 nukes

is the formula.

Choice of drugs should be guided by a resistance test and consideration of how the combination will fit into your life.

Regarding Sustiva and "anger issues", tis true perhaps not the best drug for people with pre-existing problems with mood, but on the other hand, the head effects of Sustiva sometimes amount to nothing. There may be a case here for more careful consideration/looking at something else, but rule out, hmm....

US recommended combos are listed here (AIDSMEDS lesson)

- matt

[sacinsc]

Thanks Matt,

Once my doc found out that I was moving to ORlando cause yep I got the job teaching middle school! HOORAY! I leave tomorrow for Orlando, he opted to not put me on meds and let an ID doc in Orlando do it. I went ahead and scheduled the appointment for Friday morning. We will see what he says, but I still leaning towards it. My body has been through a lot this year. Severe depression for 9 months, syphilis, ruptured appendix (and that took over 2 months to heal) and finally the seroconversion. Erring on the side of caution since falling to a CD4 count near 200 is not something I dare deal with, I would prefer to go on the meds.

Maybe I am crazy, I dont know. Ill know more on Friday. I have no resistants to drugs so lets take a chance, have others to deal with. I dont know, im exhausted from traveling from DC to SC, then tomorrow i go on to FL.